UTMB Healthcare Epidemiology

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Bioterrorism & Emerging
Infectious Diseases Plan

Detection of Outbreaks

Syndrome-based criteria
Rapid response to a bioterrorism-related outbreak requires prompt identification of its onset. Because of the rapid progression to illness and potential for dissemination of some of these agents, it may not be practical to await diagnostic laboratory confirmation. Instead, it will be necessary to initiate a response based on the recognition of high-risk syndromes.

Epidemiologic features
Epidemiologic principles must be used to assess whether a patient’s presentation is typical of an endemic disease or is an unusual event that should raise concern. Features that should alert healthcare providers to the possibility of a bioterrorism-related outbreak include:

A rapidly increasing disease incidence (e.g., within hours or days) in a normally healthy population.

An epidemic curve that rises and falls during a short period of time.

An unusual increase in the number of people seeking care, especially with fever, respiratory, or gastrointestinal complaints.

An endemic disease rapidly emerging at an uncharacteristic time or in an unusual pattern.

Lower attack rates among people who had been indoors, especially in areas with filtered air or closed ventilation systems, compared with people who had been outdoors.

Clusters of patients arriving from a single locale.

Large numbers of rapidly fatal cases.

Any patient presenting with a disease that is relatively uncommon and has bioterrorism potential (e.g., inhalation anthrax, or pulmonary tularemia or plague).

Clinical Microbiology Laboratory
All specimens obtained for diagnostic purposes will be sent to the Clinical Microbiology Laboratory (Microbiology Specimen Receiving, McCullough 5.137). All specimens should be labeled with the suspected bioterrorism agent. The laboratory in turn may send the specimen to the TDH, CDC, or another reference laboratory. Employees in the Clinical Microbiology laboratory will receive education about the microbiology of bioterrorism agents, unique growth requirements, identification, and specific handling instructions, including information on how to send the organisms through the mail.

Campus Police
In the event of a mass exposure, campus security will be used to maintain order. Areas of the campus may be secured to provide patient triage or patient care. Campus security will work with Galveston Police or state and federal officials if necessary. Patients may be quarantined in their homes. Campus Security will support this city/state mandate and help with communications and potential hysteria.

Psychological Aspects of Bioterrorism
Following a bioterrorism-related event, fear and panic can be expected from both patients and healthcare providers. Psychological responses following a bioterrorism event may include horror, anger, panic, unrealistic concerns about infection, fear of contagion, paranoia, social isolation, or demoralization. Mental Health Support Personnel (e.g., psychiatrists, psychologists, social workers, clergy, and volunteer groups) will assist in collaboration with emergency response agencies and the media. Local, state, and federal media experts can provide assistance with communications needs. The following issues need to be addressed to alleviate the public fear:

Treat anxiety in unexposed persons who are experiencing somatic symptoms (e.g., with reassurance, or diazepam-like anxiolytics as indicated for acute relief of those who do not respond to reassurance).

Fearful or anxious healthcare workers may benefit from their usual sources of social support, or by being asked to fulfill a useful role (e.g., as a volunteer at the triage site).

Patient, Visitor, and Public Information
Clear, consistent, understandable information should be provided (e.g., via fact sheets) to patients, visitors, and the general public. During bioterrorism-related outbreaks, visitors may be strictly limited.

Community Response
UTMB is a key component in the community-based bioterrorism plan. Emergency medical services, police, fire and rescue workers will be educated about the signs and symptoms of various biologic agents and be knowledgeable of the UTMB triage program for each organism. The Galveston County Health District will play an integral part in the UTMB Bioterrorism Preparedness Plan.

Emergency Medical Services
Emergency Medical Services will be provided by the Galveston Area Ambulance Authority (GAAA). During a terrorist attack, communication will be established and maintained between UTMB and GAAA.